Background: VRE infection occurs in about 10% of LT patients (pts) and is associated with increased length of hospital stay and decreased survival. Some risk factors have been identified, but studies have not focused on surgical infections, which are potentially preventable. We describe the incidence, risk factors, and clinical characteristics of VRE surgical infections following LTx.

Methods: Single-center, retrospective review of all adult LT performed in 2009-2010. Primary outcome was occurrence of VRE surgical infection (surgical wound infection, peritonitis and intra or peri-hepatic abscess) in the 1^st 30 days following LT.

Results: 245 LT in 236 pts were evaluated. Median age was 56 (22-79), 61% were male. 2% of pts had combined transplants (3 liver/kidney, 2 liver/lung, 1 liver/heart). Deceased donors were used in 88%. 7% of LT were for a 2^nd graft and 0.4% for a 3^rd graft. The incidence of VRE surgical infection was 7.3%. The types of infection were: peritonitis in 9 (50%), intra or peri-hepatic abscess in 6 (33.3%) and wound infection in 3 (16.7%). All abscesses were drained surgically. In univariate analysis, pts with VRE surgical infections were more likely to have had a bacterial (OR 5.42; 95% CI 2, 14.71; p=0.0009) or fungal (14.1; 1.86,106.49; p=0.01) infection and received antibiotics (abx) in the 3 months preceding LT (10.3; 2.32,46.02; p=0.002), to be VRE colonized pre-LT (5.27; 1.81,15.33; p=0.002)and to be on dialysis pre-LT (3.25; 1.23,8.62; 0.02). Pts with VRE surgical infections received more packed red blood cells (PRBC) (13 vs 7 units, p=0.0012) and fresh frozen plasma (11 vs 6 units, p=0.0182) intra-op, had higher rate of dehiscence (OR 6.97; 95% CI 1.19, 40.98; p=0.03) and reoperation (OR 18.6; 95% CI 5.18,67.04; p<0.0001) and longer hospitalization (53.3 vs 16.9 days, p=<0.0001) and ICU stay (15 vs 5 days, p=0.0005). In multivariate analysis, receipt of abx in the 3 months preceding LT (OR 9.4; 95% CI 2.08, 42.5; p=0.0036) and receipt of more than 8 units of PRBC (6.5; 1.80,23.6; p=0.004) were associated with VRE surgical infection. Mortality at 30 days was 4.1% and did not differ between the groups.

Conclusions: VRE surgical site infections are common post-LT and associated with increased morbidity but not mortality. Receipt of abx pre-LT and of more than 8 units of PRBC intra-op are risk factors. Further analysis is needed to better identify a subset of high-risk patients who may benefit from targeted peri-operative anti-VRE prophylaxis.

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